UWorld

Question 1

hepatic lesion on screening US

Answer 1

< 1 cm; repeat in 3 months

> 1 cm: AFP level and 4 phase MRI

Question 2

how often to do screening US for HCC in Hep C

Answer 2

q 6 months

Question 3

tx choice of severe UC flare

Answer 3

> 6 BM

Glucorticoids and high dose ASA

Question 4

when to initate abx in UC flare

Answer 4

cipro/flagyl

only when signs of systemic tox (high fever, leukocytosis, or toxic meg/peritonitis)

Question 5

when to add additional therapy in severe UC flare

Answer 5

anti-TNF if no response after 7-10 days of therpay

Question 6

repeat colon if a patient with poor prep

Answer 6

within the year

Question 7

tubular adenoma interval

Answer 7

5 years

Question 8

indication for neostigmine in pseudo bowel obstruction

Answer 8

fail 24-48 hours of conservative therapy or have cecal dilation > 12 cm
if fail this or have containdications - colonic decompression

Question 9

gastrin level

Answer 9

1 week off ppi, < 110 rules out, > 1000 highly suggestive (ph stomach), between 110-1000- secretin stim test

Question 10

platypnea/orthedexia clinical features of …. and how to diagnose…

Answer 10

Hepatopulmonary syndrome

contrast echo

Question 11

treat candidal esophagitis

Answer 11

oral fluconazole (14-21 days) if typical symptoms and oral thrush. 
If no thrush, then proceed to EGD

Question 12

which ulcers need relook? gastric or duodenal

Answer 12

gastric

Question 13

if H.pylori negative on biopsy during egd, follow up?

Answer 13

can be false negative b/c of bleed and medicaitons, do outpatient urea breath test or stool antigen test

Question 14

timing of colonoscopy in patient with family member with CRC

Answer 14

10 years from diagnosis or age 40 whichever comes first

Question 15

timing of colonoscopy for UC or chrons

Answer 15

8 years after diagnosis q 1-3 years

Question 16

SAAG and TP for cirrhosis

Answer 16

SAAG > 1.1, TP < 2.5

Question 17

SAAG and TP for HF

Answer 17

SAAG > 1.1 and TP > 2.5

Question 18

SAAG and TP for nerphrotic

Answer 18

SAAG < 1.1. and TP < 2.5

Question 19

tx of choice of sigmoid volvulus

Answer 19

sigmoid endoscopy for decompression (don’t use if gangrene or perf)

Question 20

PBC testing

Answer 20

AMA

very high cholesterol

Question 21

tx PBC

Answer 21

urseodeoxycholic acid

Question 22

blood disorder assoicated iwth Hep C

Answer 22

cryoglobinemia

Question 23

puritis and xathelsmas

Answer 23

PBC

Question 24

what type of anal fissures require additional imaging

Answer 24

lateral and anterior

Question 25

dx of SIBO made by

Answer 25

positive hydrogen breathe test or jejugunal aspiration with high level of bacteria

Question 26

tx SIBO

Answer 26

rifaxamin

Question 27

diuretics for ascites

Answer 27

spiranolactone 100 and lasix 40m

Question 28

when is endoscopy indicated for medication induced esophagitis

Answer 28

> 1 week after drug withdrawl or severe symptoms (atypical)

Question 29

what additional testing do people with celiac need

Answer 29

DEXA and TSH, pneumoncoccal (despite age)

Question 30

common cuases of gastric varices without esophageal

Answer 30

splenic vein thrombosis

Question 31

common non-pancreatic cuases of elevated lipase

Answer 31

renal insuff, dka, and obstruction/ileus

Question 32

PUD timing of symptoms

Answer 32

before meals or empty stomach given gastric acid secretion without food buffer

Question 33

how to diagnose gastroporesis

Answer 33

need to rule out impaired gastric emptying gastric motility and GOO with upper endoscopy and CT to exclude mass. if negative, then gastric emptying study.

Question 34

ileal resection leads to which vitamin Def

Answer 34

bad bile acids leads to ADEK malab and B12 def. Secretory diarrhea 2/2 to bile acids in the colon

Question 35

tx anal fissure

Answer 35

topical nitroglycerine

Question 36

which type of anal fissures require more investigtation

Answer 36

- lateral/anterior, multiple - rectal bleeding - failure to respond after 8 weeks of optimal medical therapy

Question 37

colonic secratague

Answer 37

IBS-C (lupiprostone and linaclotide)

Question 38

persistently elevated lipase after acute panc

Answer 38

pancreatic pseudocyst

Question 39

labs for Hereditary hematochromatosis

Answer 39

transferring sat > 50 and ferritin > 1000

Question 40

triple drug therapy for H.oylroi

Answer 40

PPI, amox (metro if pen allergic) , clarithromycin

Question 41

warning signs in IBS that require further eval

Answer 41

rectal bleeding nocturnal symptoms abnormal labs weight loss

Question 42

tx of choice diarrhea persistent IBS

Answer 42

rifaximin

Question 43

colon cancer and primary sclerosing cholangitis

Answer 43

colonoscopy at diagnosis and if + for IBD q year otherwise q 5 years

Question 44

antibodies for autoimmune hepatitsi

Answer 44

ANA and ASMA

Question 45

dyspepsia without GERD

Answer 45

if less than 60, then H.pylori testing | if greater than 60, EGD

Question 46

surveillance for Barreetts

Answer 46

no- 3-5 years low grade - 6-12 months high grade - endoscopic ablation

Question 47

initial episode of C.diff tx

Answer 47

vancomycin po or findamicin

Question 48

recurrence of c.diff

Answer 48

vancomycin with prolonged pulsed taper or findamaxin

Question 49

fulminant c.diff tx

Answer 49

metronidazole IV + high dose vanco PO (rectal if ileus is present)

Question 50

TOC fistulizing chronics

Answer 50

TNF

Question 51

screening colonoscopy in IBD

Answer 51

at 8 years and then 1-3 years therafter